Outcome in children receiving continuous venovenous hemofiltration

Objective. Continuous venovenous hemofiltration (CVVH) alone or with dialys is (D) has become an important supportive therapy for critically ill childr en with acute renal failure. Previous reports of pediatric patient outcome either mix CVVH/D with other renal replacement modalities or do not examine severity of illness. The current study examines only outcomes of children receiving CVVH/D using Pediatric Risk of Mortality (PRISM) scores to contro l for severity of illness. Patients. Twenty-one patients (mean age: 8.8 +/- 6.3 years; mean weight: 28 .3 +/- 20.8 kg) received 22 courses of CVVH/D. Outcomes. Nine (42.8%) of 21 patients survived. Nine (75%) of 12 deaths occ urred within 25 days of pediatric intensive care unit (PICU) admission. Mea n PRISM score at PICU admission and CVVH initiation were 13.1 +/- 5.8 and 1 5.4 +/- 8.9, respectively. Mean patient weight, age, PRISM score at PICU ad mission and at CVVH/D initiation, maximum pressor number, estimated glomeru lar filtration rate at CVVH/D initiation and change in mean airway pressure did not differ between survivors and nonsurvivors. The degree of fluid ove rload at CVVH/D initiation was significantly lower in survivors (16.4% +/- 13.8%) compared with nonsurvivors (34.0% +/- 21.0%), even when controlled f or severity of illness by PRISM score. Mean cost of providing CVVH/D accoun ted for only 1% of total PICU cost per patient. Conclusions. The pattern of early multiorgan system failure and death, mini mal relative cost of CVVH/D provision, and potential for improved outcome w ith initiation of CVVH/D at lesser degrees of fluid overload are factors th at may support early initiation of CVVH/D in critically ill children with a cute renal failure.